Provider Demographics
NPI:1073771952
Name:BOZAN, LISA CHRISTINE (PA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:CHRISTINE
Last Name:BOZAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:MRI 1026
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-7467
Mailing Address - Fax:212-794-5812
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:MRI 1026
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-7467
Practice Address - Fax:212-794-5812
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005747363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical